Ecoli in the Lungs

I am a 59 year old female. I suffer from Alpha1 Antitrypsin Deficiency and Bronchiectasis. I have been dealing w/my chronic illness for 11 years.

I have frequent resp infections and on alot of antibiotics and pred.The anti of choice has been Leviquin. Cultures have been done in the past to check for resistance and all seemd to be going well. And yet..after two to three weeks off the anti's the infection would come back. And so it went..two weeks on..two weeks off..another infection so forth and so on.

Fast Forward...I was fortunate enough to have not had an infection for almost 6 mos. That was a big deal for me. December I contracted another infection..three admissions for IV meds and yet the old pattern has returned.

This infection I have now ..sputum cultures were collected and tested. It appears ecoli has colonized in my lungs. Leviquin, Bactrim and Cipro were tested for potency..all were resistant. The drug that responded was Augmentin. So I will be starting that along w/the pred for 21 days and then another culture will be done.

My question is..how in the world did I get ecoli in my lungs? And in the opinion of someone who is experienced w/this can you tell me if the treatment described above is effective enough?

I'm sorry you've been having so much trouble with lung infections--that must be very difficult for you. Unfortunately, that is the pattern with people who suffer from bronchiectasis.

In people who have normal healthy lungs and who are NOT in hospital and who have NOT been exposed to antibiotics, when pneumonias happen they tend to be from gram POSITIVE organisms like pneumococcus or Staphylococcus....i.e. things that live on your skin. In people who have abnormal lungs, who've been on a lot of antibiotics or who sick in hospital, they tend to get gram NEGATIVE organisms. These bugs are the ones that live in your stool generally and E. coli is a very common one.

In your case, there are small amounts of E. coli in the mouth which are constantly inhaled in to the lungs, but these are taken care of by your immune system; however, in someone who has abnormal lung architecture as yourself, and has been on multiple courses of antibiotics, the E. coli is able to colonize the lungs, and the resistant ones are "selected out" because all the other bugs around them are being killed by the antibiotics while they themselves live. Given that you've probably had a lot of fluoroquinolone exposure, it's no surprise the E. coli is resistant.

It's a difficult situation in people who have chronic lung disease like COPD or bronchiectasis. You want to minimize antibiotic exposure as much as you can, but on the other hand, if the person is really ill and has a fever with increased cough and shortness of breath, you have no choice BUT to give antibiotics. That's why with bronchiectasis, as your respirologist has likely told you, it is very important to maintain all the activities that help to optimize drainage and try to PREVENT infections in the first place. There are many different things that can help do this, and I'm sure you know about all of them.

I have a bit of an unrelated question for you: alpha1 antitrypsin defiiciency generally results in panacinar emphysema rather than bronchiectasis. Do you have bronchiectasis for another reason on TOP of your A1ATD? Did you have a lot of lung infections when you were a kid? Did you have whooping cough when you were a kid?

I fully understand why you would be scared. It is uncommon to have a respiratory infection caused by E. coli.

E. coli is normally found in the large intestine. It can cause other infections such as UTI's or as in your case - a respiratory infection. In these cases, somehow the bacteria was transmitted to the site of infection. We can only guess as to how that happened.

As far as Augmentin, if the lab results shows the bacteria is sensitive to it then it is the drug of choice. Augmentin is a broad spectrum antibiotic.

Thanks for your detailed informative message. Im not sure if I had whooping cough as a child or not..but I do recall having alot of colds and respiratory infections growing up.

As far as how I got bronchiectasis..let me say I do have emphysema as well..and though I dont know the reason I have bronchiectasis I've been informed it's not uncommon for Alpha1 Patients to develop this disorder ..I know others on my support list who have bronchiectasis as well..

Thanks again for your information..I'm gonna share this with my dr and some other support group members.

Hi Sandie I also have Alfa 1 question for you do get
weekly prolastin infusions?? This made a big improvement
in my life as far as getting sick all the time. I never had
Ecoli in my lungs but I do know that Leviquin is a vary
strong antibiotic thats the only thing that works for me
anymore. Being a fellow Alfa I under stand. I wish you
all the luck in the world to kick this in the butt.

Hi Sandie I hope you are feeling better and the meds are working.
Us A1As have to be careful ya I use to get weekly infusions but
5 years ago I got a single lung transplant that save my life
thank god. I go to the support meetings at the hospital an talk
to the preop patients and try to let them know what they have
to look forward to the ups and downs of postop surgery. I find it
is good therapy for me and all involved. I wish you all the luck
with your battle with A1A it sounds like you are a strong person
and are doing the best you can.